Retirement Ranches Inc.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents were provided with a choice about aspects of his/her life that are significant to the residents for 1 (R #1) of 5 (R #1, R #2, R #3, R #4, and R #5) residents reviewed by not having the choice to shower when they wanted. This deficient practice could likely result in residents feeling a loss of humanity (the quality of being human) by and a loss of dignity (the importance and value that a person has, that makes other people respect them or makes them respect themselves).

Inspectors wroteBased on record review and interview, the facility failed to: 1. Ensure that all residents can request or refuse emergency and lifesaving care by failing to obtain and review residents' wishes regarding code status (instructions regarding the type of medical interventions a person wants in the event of a medical emergency), medical interventions (comfort measures such as pain relief or use of oxygen, use of medical treatment such as intubation) and artificial hydration/nutrition (the provision of nutrition and fluids by methods other than normal eating and drinking), 2. [...]

Inspectors wroteBased on observation and interview, the facility failed to store and serve food under sanitary conditions by not ensuring food items stored in facility's freezer were opened, labeled, and dated. This deficient practice is likely to affect 83 residents listed on the resident census list provided by the Administrator on 09/22/25 and could likely lead to foodborne illnesses in residents if food is not being stored properly and safe food handling practices are not adhered to.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents and/or their representatives were informed in advance of what medications they received and understood the reasons, risks, and benefits of the medications for 1 (R #2) of 2 (R #2 and R #5) residents reviewed for unnecessary medications. If the residents or their representatives are not informed of the risks and benefits of the medication or treatment alternatives, they are not able to make informed decisions regarding residents' care.

Inspectors wroteBased on observation and interview, the facility failed to provide personal privacy for 3 (R #29, R #61 and R #64) of 4 (R #4, R #29, R #61, and R #64) residents reviewed for privacy when staff administered medications in the commons area of the building after not giving the residents the chance to choose whether they received their medications privately. This deficient practice is likely to cause residents to feel embarrassed or ashamed.

Inspectors wroteBased on observations and interviews, the facility failed to utilize enhanced barrier precautions (EBP; an infection control intervention) when providing direct care to 3 (R #4, R #12, and #15) of 3 (R #4, R #12, and #15) residents. Failure to utilize enhanced barrier precautions when performing direct care has the potential to spread organisms, diseases, and other health conditions among the residents.

Inspectors wroteBased on record review and interview, the facility failed to update a resident's care plan to reflect new diagnosis and treatment plans for 1 (R #84) of 7 (R #1, R #8, R #10, R #14, R #30, R #80, and R #84) residents reviewed for comprehensive care plans. This deficient practice could likely result in resident care not being closely monitored and not managed to meet the needs of the residents.

Inspectors wroteBased on observation, record review, and interview, the facility failed to provide two-person assistance for 1 (R #61) of 3 (R #4, R #29, and R #61) residents reviewed for transfer care (assisting a resident to move from one place to another). This deficient practice could likely result in R #61 being injured during a transfer.

Inspectors wroteBased on interviews, the facility failed to ensure that residents are able to receive mail on Saturdays for all 83 residents residing at the facility as identified on the census provided by the Administrator (ADM) on 09/23/25. This deficient practice is likely to result in residents not receiving timely communication which could result in feelings of isolation.

Inspectors wroteBased on observation and interview, the facility failed to ensure the treatment cart on the 200 hall was locked while unattended. This deficient practice had the potential to affect all 34 people residing in the [NAME] side (facility pods one, two, and three) of the facility by allowing unauthorized people access to their medical supplies and personal health information.

Inspectors wroteBased on observations, menu review, interview, and facility policy review, the facility failed to ensure menus were in place for all physician prescribed diets and failed to follow the menu for 80 of 80 census residents. This failure has the potential for residents to get the incorrect food in accordance with their diets; not receive nutritionally adequate meals; and receive repetitive food items.

Inspectors wroteBased on observations, record reviews, interviews, and facility policy review revealed the facility failed to ensure one out of six medication carts and one out of two treatments carts were securely locked when unattended. This failure put the residents at risk of taking medications that were not theirs.

Inspectors wroteBased on observations, record review, and interview the facility failed to prevent an accident by not providing a safe transfer for 1 (R #4) of 4 (R #3, 4, 5 and 6) residents reviewed for falls when the facility failed to: 1. Ensure staff were adequately trained on how to use transfer lifts. 2. Identify number of staff needed for each resident to ensure a safe transfer. 3. Have a method for staff to determine for which residents the leg strap should be used. This deficient practice likely resulted in R #4 falling during transfer and sustaining a new fracture around the hardware in her femur (thigh bone) and a broken pelvis.

Inspectors wroteBased on observation, record review, and interview, the facility failed to meet professional standards of quality for 1 (R # 3) of 3 (R #3, 4, 5) resident reviewed for pain medications by not doing a thorough assessment, notification, and documentation on admission of the resident. This deficient practice could likely cause an overdose of narcotic medication and potentially death if the Nurse Practitioner (NP) is unaware of all medications the resident is currently taking.

Inspectors wroteBased on observation, record review, and interview, the facility failed to meet professional standards of quality for 1 (R #45 ) of 1 (R #45) residents by not administering oxygen in accordance with the physician's orders. If the facility is not administering oxygen as prescribed, the resident is not likely to get the therapeutic results as needed. The findings for R #45 are: A. Record review of R #45's face sheet revealed the resident was admitted on [DATE] with following diagnoses. 1. Respiratory failure, unspecified with hypoxia (a condition that affects breathing function or the lungs, and causes low oxygen or high carbon dioxide levels in the blood) . 2. Hypertensive heart disease without heart failure (a long-term condition related to high blood 3pressure). 3. Shortness of breath (blanket term for a group of diseases that block airflow from the lungs). B. [...]